Please use this identifier to cite or link to this item: https://ahro.austin.org.au/austinjspui/handle/1/33508
Title: Implementing structured pathology reporting protocol for non-melanocytic skin cancers: practical considerations.
Austin Authors: Gupta, Ruta;Selinger, Christina I;Ashford, Bruce;Chua, Margaret S T;Clark, Jonathan R;Damian, Diona L;Jackett, Louise A ;James, Craig;Johnson, Stuart;Ladwa, Rahul;Lambie, Duncan;McKenzie, Catriona;Tan, Swee T;Scolyer, Richard A
Affiliation: Faculty of Medicine and Health, The University of Sydney, Sydney, NSW, Australia; Department of Tissue Pathology and Diagnostic Oncology, Royal Prince Alfred Hospital, NSW Health Pathology, Sydney, NSW, Australia.
Royal College of Pathologists of Australasia, Sydney, NSW, Australia.
Illawarra Health and Medical Research Institute, Wollongong, NSW, Australia; Department of Head and Neck Surgery, Sydney Head and Neck Cancer Institute, Chris O'Brien Lifehouse, Sydney, NSW, Australia; Illawarra and Shoalhaven Local Health District, Wollongong, NSW, Australia; School of Medicine, University of Wollongong, Wollongong, NSW, Australia.
Department of Radiation Oncology, Peter MacCallum Cancer Centre, Melbourne, Vic, Australia; The Sir Peter MacCallum Department of Oncology, The University of Melbourne, Melbourne, Vic, Australia.
Department of Head and Neck Surgery, Sydney Head and Neck Cancer Institute, Chris O'Brien Lifehouse, Sydney, NSW, Australia; Royal Prince Alfred Institute of Academic Surgery, Sydney Local Health District, Sydney, NSW, Australia; Central Clinical School, Faculty of Medicine and Health, The University of Sydney, Sydney, NSW, Australia.
Discipline of Dermatology, Bosch Institute, University of Sydney, and Royal Prince Alfred Hospital Sydney, Sydney, NSW, Australia; Melanoma Institute Australia, The University of Sydney, Sydney, NSW, Australia.
Pathology
Mile End, Adelaide, SA, Australia.
Wellington SCL, Hutt Valley Hospital Site, New Zealand.
Department of Cancer Care Services, Princess Alexandra Hospital, Woolloongabba, Qld, Australia; Faculty of Medicine, University of Queensland, Herston, Qld, Australia.
Princess Alexandra Hospital, Pathology Queensland, Brisbane, Qld, Australia; Frazer Institute, University of Queensland, Brisbane, Qld, Australia.
Faculty of Medicine and Health, The University of Sydney, Sydney, NSW, Australia; Department of Tissue Pathology and Diagnostic Oncology, Royal Prince Alfred Hospital, NSW Health Pathology, Sydney, NSW, Australia.
Gillies McIndoe Research Institute, Wellington, New Zealand; Wellington Regional Plastic, Maxillofacial and Burns Unit, Hutt Hospital, Wellington, New Zealand; Department of Surgery, The Royal Melbourne Hospital, The University of Melbourne, Melbourne, Vic, Australia.
Faculty of Medicine and Health, The University of Sydney, Sydney, NSW, Australia; Department of Tissue Pathology and Diagnostic Oncology, Royal Prince Alfred Hospital, NSW Health Pathology, Sydney, NSW, Australia; Melanoma Institute Australia, The University of Sydney, Sydney, NSW, Australia; Charles Perkins Centre, The University of Sydney, Sydney, NSW, Australia.
Issue Date: Oct-2023
Date: 2023
Publication information: Pathology 2023-10; 55(6)
Abstract: Non-melanocytic skin cancers (NMSCs) account for five times the incidence of all other cancers combined and cost US $6 billion annually. These are the most frequent specimens encountered in community pathology practice in many Western countries. Lack of standardised structured pathology reporting protocols (SPRPs) can result in omission of critical information or miscommunication leading to suboptimal patient management. The lack of standardised data has significant downstream public health implications, including insufficient data for reliable development of prognostic tools and health-economy planning. The Royal College of Pathologists of Australasia has developed an NMSC SPRP. A multidisciplinary expert committee including pathologists, surgeons, dermatologists, and radiation and medical oncologists from high volume cancer centres was convened. A systematic literature review was performed to identify evidence for including elements as mandatory standards or best practice guidelines. The SPRP and accompanying commentary of evidence, definitions and criteria was peer reviewed by external stakeholders. Finally, the protocol was revised following feedback and trialled in multiple centres prior to implementation. Some parameters utilised clinically for determining management and prognosis including tumour depth, lymphovascular invasion or distance to the margins lack high level evidence in NMSC. Dermatologists, surgeons, and radiation oncologists welcomed the SPRP. Pathologists indicated that the variety of NMSC specimens ranging from curettes to radical resections as well as significant differences in the biological behaviour of different tumours covered by the NMSC umbrella made use of a single protocol difficult. The feedback included that using a SPRP for low risk NMSC was neither clinically justified nor compensated adequately by the Australian Medicare Reimbursement Schedule. Following stakeholder feedback, the SPRP implementation was restricted to excision specimens of head and neck NMSC; and low-risk NMSC, such as superficial basal cell carcinoma, were excluded. Implementing NMSC SPRP fulfils an unmet clinical need. Unlike other cancers, NMSCs generate a range of specimen types and are reported in a wide range of pathology practices. Limiting use of SPRP to NMSC at higher risk of progression and providing formatted templates for easy incorporation into laboratory information systems were essential to successful deployment. In the future, further consideration should be given to implementing the SPRP to include all relevant specimens, including non-head and neck and low-risk NMSC specimens.
URI: https://ahro.austin.org.au/austinjspui/handle/1/33508
DOI: 10.1016/j.pathol.2023.07.003
ORCID: 
Journal: Pathology
PubMed URL: 37573165
ISSN: 1465-3931
Type: Journal Article
Subjects: Basal cell carcinoma
cutaneous
depth of invasion
lymphovascular invasion
macroscopic
margins
microscopic
non-melanocytic skin cancers
perineural invasion
squamous cell carcinoma
structured reporting protocol
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